Regence leads the way in collaborative care

July 31, 2014

By Don Antonucci, President, Regence BlueShield

Over the past decade, a shift has been occurring in the way health care is delivered, moving away from traditional fee-for-service to a more collaborative, value-based model. That shift accelerated with the implementation of the Affordable Care Act (ACA), and we’re now at a point of fundamental system change.

The ACA encouraged the formation of accountable care organizations (ACOs) in which groups of providers take on clinical and financial responsibility for the care of their patients. For several years before the implementation of the ACA, Regence was leading the way in creating collaborative care arrangements through a variety of initiatives that incorporated new payment models, products, support, and technology to foster collaborative patient-physician relationships with the goal of improving health outcomes and enhancing member satisfaction.

Some of the specific arrangements Regence has created include patient-centered medical homes, in which integrated teams of doctors, nurses and case managers work with patients with serious health issues; total cost of care contracts with hospitals and medical groups which reward providers for the outcome of the care they provide, rather than on the quantity of their services; as well as accountable care organizations (ACOs).

At the core of each of these arrangements is a strong relationship between patients and their physicians. The role of the health plan is to support this relationship through clinical programs and data exchange that helps the physicians to work with their patients to manage their care effectively and efficiently.

Results from these early initiatives show that they have been successful – a patient-centered medical home pilot was instrumental in significant financial savings for a large employer, through cost savings and increases in productivity. Additional results from total cost of care arrangements will be available soon, and we’ll share them in future posts.